Bottom Line:
Multi-vessel disease was more common than single vessel disease (p < 0.001), and the left anterior descending (LAD) artery (35.8%) and its proximal segment (19.1%) were most frequently involved (all p < 0.001).Regarding the different degrees of stenosis, mild narrowing (36.9%) was most common (p < 0.001); however, a significant difference was not observed between non-obstructive and obstructive stenosis (50.4% vs. 49.6%, p = 0.855).In addition, DM reduced the sex differential in CT findings of CAD.

Background: Coronary artery disease (CAD) is a common and severe complication of type 2 diabetes mellitus (DM). The aim of this study is to identify the features of CAD in diabetic patients using coronary CT angiography (CTA).

Methods: From 1 July 2009 to 20 March 2010, 113 consecutive patients (70 men, 43 women; mean age, 68 ± 10 years) with type 2 DM were found to have coronary plaques on coronary CTA. Their CTA data were reviewed, and extent, distribution and types of plaques and luminal narrowing were evaluated and compared between different sexes.

Results: In total, 287 coronary vessels (2.5 ± 1.1 per patient) and 470 segments (4.2 ± 2.8 per patient) were found to have plaques, respectively. Multi-vessel disease was more common than single vessel disease (p < 0.001), and the left anterior descending (LAD) artery (35.8%) and its proximal segment (19.1%) were most frequently involved (all p < 0.001). Calcified plaques (48.8%) were the most common type (p < 0.001) followed by mixed plaques (38.1%). Regarding the different degrees of stenosis, mild narrowing (36.9%) was most common (p < 0.001); however, a significant difference was not observed between non-obstructive and obstructive stenosis (50.4% vs. 49.6%, p = 0.855). Extent of CAD, types of plaques and luminal narrowing were not significantly different between male and female diabetic patients.

Conclusions: Coronary CTA depicted a high plaque burden in patients with type 2 DM. Plaques, which were mainly calcified, were more frequently detected in the proximal segment of the LAD artery, and increased attention should be paid to the significant prevalence of obstructive stenosis. In addition, DM reduced the sex differential in CT findings of CAD.

Figure 2: This image shows many calcified plaques, the density of which is significantly higher than contrast-enhanced lumen.

Mentions:
Two cardiovascular radiologists independently analyzed the images. Discrepancies in their interpretations were resolved by consensus. Both observers were blinded to the medical histories, clinical diagnoses and results of other investigations for all patients. Number of diseased coronary vessels and segments, number and types of plaques and grading of stenosis caused by plaques were evaluated. In this study, coronary arteries were divided into four branches: left main (LM), left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) (Figure 1). According to the standard of the American Heart Association, the left and right coronary arteries were divided into 15 segments [9]. Plaques were classified as calcified plaque (plaques with higher CT density than contrast-enhanced lumen) (Figure 2); non-calcified plaque (plaques with lower CT attenuation than contrast-enhanced lumen without any calcification) (Figure 3) and mixed plaque (non-calcified and calcified elements in single plaque) (Figure 4) [10]. Overall, coronary artery stenosis caused by plaques was classified as obstructive and non-obstructive using a 50% threshold of luminal narrowing. In addition, grading of stenosis was further classified as normal appearing (<25%), mild (25%-49%), moderate (50%-74%) and severe (≥75%) narrowing [11]. The degree of stenosis was assessed on the basis of two orthogonal views.

Figure 2: This image shows many calcified plaques, the density of which is significantly higher than contrast-enhanced lumen.

Mentions:
Two cardiovascular radiologists independently analyzed the images. Discrepancies in their interpretations were resolved by consensus. Both observers were blinded to the medical histories, clinical diagnoses and results of other investigations for all patients. Number of diseased coronary vessels and segments, number and types of plaques and grading of stenosis caused by plaques were evaluated. In this study, coronary arteries were divided into four branches: left main (LM), left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) (Figure 1). According to the standard of the American Heart Association, the left and right coronary arteries were divided into 15 segments [9]. Plaques were classified as calcified plaque (plaques with higher CT density than contrast-enhanced lumen) (Figure 2); non-calcified plaque (plaques with lower CT attenuation than contrast-enhanced lumen without any calcification) (Figure 3) and mixed plaque (non-calcified and calcified elements in single plaque) (Figure 4) [10]. Overall, coronary artery stenosis caused by plaques was classified as obstructive and non-obstructive using a 50% threshold of luminal narrowing. In addition, grading of stenosis was further classified as normal appearing (<25%), mild (25%-49%), moderate (50%-74%) and severe (≥75%) narrowing [11]. The degree of stenosis was assessed on the basis of two orthogonal views.

Bottom Line:
Multi-vessel disease was more common than single vessel disease (p < 0.001), and the left anterior descending (LAD) artery (35.8%) and its proximal segment (19.1%) were most frequently involved (all p < 0.001).Regarding the different degrees of stenosis, mild narrowing (36.9%) was most common (p < 0.001); however, a significant difference was not observed between non-obstructive and obstructive stenosis (50.4% vs. 49.6%, p = 0.855).In addition, DM reduced the sex differential in CT findings of CAD.

Background: Coronary artery disease (CAD) is a common and severe complication of type 2 diabetes mellitus (DM). The aim of this study is to identify the features of CAD in diabetic patients using coronary CT angiography (CTA).

Methods: From 1 July 2009 to 20 March 2010, 113 consecutive patients (70 men, 43 women; mean age, 68 ± 10 years) with type 2 DM were found to have coronary plaques on coronary CTA. Their CTA data were reviewed, and extent, distribution and types of plaques and luminal narrowing were evaluated and compared between different sexes.

Results: In total, 287 coronary vessels (2.5 ± 1.1 per patient) and 470 segments (4.2 ± 2.8 per patient) were found to have plaques, respectively. Multi-vessel disease was more common than single vessel disease (p < 0.001), and the left anterior descending (LAD) artery (35.8%) and its proximal segment (19.1%) were most frequently involved (all p < 0.001). Calcified plaques (48.8%) were the most common type (p < 0.001) followed by mixed plaques (38.1%). Regarding the different degrees of stenosis, mild narrowing (36.9%) was most common (p < 0.001); however, a significant difference was not observed between non-obstructive and obstructive stenosis (50.4% vs. 49.6%, p = 0.855). Extent of CAD, types of plaques and luminal narrowing were not significantly different between male and female diabetic patients.

Conclusions: Coronary CTA depicted a high plaque burden in patients with type 2 DM. Plaques, which were mainly calcified, were more frequently detected in the proximal segment of the LAD artery, and increased attention should be paid to the significant prevalence of obstructive stenosis. In addition, DM reduced the sex differential in CT findings of CAD.